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Confirmed: The Conclusion by NICE that CBT is not an Effective Treatment for ME/CFS; Re-Analysis of a Systematic Review
Abstract
In this article, we analyzed the systematic review by Kuut et al. into the efficacy of cognitive behavioral therapy (CBT) for my algicencephalomyelitis/chronic fatigue syndrome (ME/CFS), a disease that predominantly affects women, and the eight trials in it.
We found many issues with the studies in the review, but also with the review itself.
For example, the systematic review by Kuut et al. included a researcher who was involved in seven of the eight studies in their review, and another one who was involved in five of them. Moreover, at least one of them was involved in every study in the review.
On top of that, the three professors who were involved in the systematic review, have all built their career on the CB model and the reversibility of ME/ CFS through CBT and GET and two of the systematic reviewers have a potential financial conflict of interest.
Yet they failed to inform the readers about these conflicts of interest.
Conducting a review in this manner and not informing the readers, under mines the credibility of a systematic review and its conclusion.
Regarding outcome differences between treatment and control group, it’s highly likely that the combination of non-blinded trials, subjective outcomes and poorly chosen control groups, alone or together with response shift bias and/or patients filling in questionnaires in a manner to please the investigators, allegiance bias, small study effect bias and other forms of bias, produced the appearance of positive effects, despite the lack of any substantial benefit to the patients, leading to the erroneous inference of efficacy in its absence.
That CBT is not an effective treatment is highlighted by the fact that patients remained severely disabled after treatment with it. The absence of objective improvement as shown by the actometer, employment status and objective cognitive measures, confirms the inefficacy of CBT for ME/CFS.
The systematic review did not report on safety but research by the Oxford Brookes University shows that CBT, which contains an element of graded exercise therapy, is harmful for many patients.
Finally, our reanalysis highlights the fact that researchers should not mark their own homework.
Keywords:
CBT; CFS; Chronic Fatigue Syndrome; Cognitive Behavior Therapy; Myalgic Encephalomyelitis; NICE.
https://www.scibasejournals.org/neurology/1022.pdf
Confirmed: The Conclusion by NICE that CBT is not an Effective Treatment for ME/CFS; Re-Analysis of a Systematic Review
Mark Vink1*; Alexandra Vink-Niese2
1Independent Researcher, 1096 HZ Amsterdam, The Netherlands. https://orcid.org/0000-0003-1079-5647
2Independent Researcher, 30159 Hannover, Germany. https://orcid.org/0000-0001-8018-1419 Corresponding Author: Mark Vink Independent Researcher, 1096 HZ Amsterdam, The Netherlands.
Email: markvink.md@outlook.com
Article Information
Received: Sep 03, 2024
Accepted: Oct 17, 2024
Published: Oct 24, 2024
SciBase Neurology - scibasejournals.org Vink M et al. © All rights are reserved
Citation: Vink M, Vink-Niese A. Confirmed: The Conclusion by NICE that CBT is not an Effective Treatment for ME/CFS; Re-Analysis of a Systematic Review. SciBase Neurol. 2024; 2(3): 1022.
Abstract
In this article, we analyzed the systematic review by Kuut et al. into the efficacy of cognitive behavioral therapy (CBT) for my algicencephalomyelitis/chronic fatigue syndrome (ME/CFS), a disease that predominantly affects women, and the eight trials in it.
We found many issues with the studies in the review, but also with the review itself.
For example, the systematic review by Kuut et al. included a researcher who was involved in seven of the eight studies in their review, and another one who was involved in five of them. Moreover, at least one of them was involved in every study in the review.
On top of that, the three professors who were involved in the systematic review, have all built their career on the CB model and the reversibility of ME/ CFS through CBT and GET and two of the systematic reviewers have a potential financial conflict of interest.
Yet they failed to inform the readers about these conflicts of interest.
Conducting a review in this manner and not informing the readers, under mines the credibility of a systematic review and its conclusion.
Regarding outcome differences between treatment and control group, it’s highly likely that the combination of non-blinded trials, subjective outcomes and poorly chosen control groups, alone or together with response shift bias and/or patients filling in questionnaires in a manner to please the investigators, allegiance bias, small study effect bias and other forms of bias, produced the appearance of positive effects, despite the lack of any substantial benefit to the patients, leading to the erroneous inference of efficacy in its absence.
That CBT is not an effective treatment is highlighted by the fact that patients remained severely disabled after treatment with it. The absence of objective improvement as shown by the actometer, employment status and objective cognitive measures, confirms the inefficacy of CBT for ME/CFS.
The systematic review did not report on safety but research by the Oxford Brookes University shows that CBT, which contains an element of graded exercise therapy, is harmful for many patients.
Finally, our reanalysis highlights the fact that researchers should not mark their own homework.
Keywords:
CBT; CFS; Chronic Fatigue Syndrome; Cognitive Behavior Therapy; Myalgic Encephalomyelitis; NICE.
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